Shock therapy During 1987-1994, the Russian mortality rate increased by more than half, from 1.0% to 1.6%, as life expectancy fell from 70 to 64 years! Economic output fell by almost half during 1989-1998 as wealth and income inequalities as well as crime, murder and suicide rates soared.

The dramatic increase in mortality – most pronounced for middle-aged men, mostly due to cardiovascular diseases – has been explained in terms of various factors like falling real incomes, poorer nutrition, environmental degradation, the collapse of Soviet health care, and surges in alcoholism and smoking.

However, dietary changes – less meat and dairy products, yet more bread and potatoes – could not have quickly increased cardiovascular diseases.

Deterioration of health care, smoking and changes in diet would require much more time to increase mortality by so much, while increased pollution is not an acceptable explanation due to the collapse of industrial output.

The increased intake of alcohol can, in turn, be attributed to the lower prices of spirits in the early 1990s. But this alcohol explanation does not stand up to critical scrutiny. After all, as with most other goods, demand for alcohol is inversely related to price and positively to personal income and spending capacity.

Although strongly correlated with the mortality rate, higher alcohol consumption was not an important independent cause, but also exacerbated by the same stress factors as the mortality rate itself.

The simultaneous increase in the total death rate, deaths due to external causes, and alcohol consumption were thus all driven by another factor, namely stress.

Stress What were these sources of increased stress and why did they increase premature deaths? Stress factors due to the economic ‘shock therapy’ following the demise of the Soviet Union are associated with the rise in unemployment, labour mobility, migration, divorce, wealth, and income inequalities.

A stress index incorporating these variables turns out to be a surprisingly good predictor of changes in life expectancy in post-communist economies, especially in the Russian Federation.

The evidence shows that many men in their 40s and 50s – who had lost their jobs or had to move to another job and/or another region, or experienced increases in inequalities in their country/region, or had divorced their wives – were more likely to die prematurely in the 1990s.

To reiterate, the Russian mortality crisis of the 1990s was mainly due to the shock economic reforms that led to mass, especially labour dislocations, much greater personal and family economic insecurity and sharp increases in inequalities. The resulting dramatic rise in stress factors was therefore mostly responsible for the sharp rise in mortality.